Oral Rehydration Research Articles

Phytotherapy for Diarrhea: Bridging Herbal Medicine and Modern Treatment

Diarrhea remains a significant global health issue, responsible for approximately 1.9 million deaths annually, particularly in children under five. Conventional treatment includes oral rehydration and antibiotics; however, phytotherapy, the use of plant-based remedies, offers an alternative or complementary solution, especially for cases involving chronic diarrhea or antibiotic resistance. This paper examines the historical and scientific basis of phytotherapy, its pharmacological mechanisms, clinical efficacy, and potential integration with modern medicine. Despite the lack of robust clinical data for some herbal treatments, growing interest in complementary approaches highlights the need for further research. Phytotherapy shows promise in alleviating symptoms and modulating gut health through anti-inflammatory, anti-infectious, and gut-modulating mechanisms. The integration of herbal medicine with modern treatment protocols could enhance the therapeutic approach to managing diarrhea and improve patient outcomes, especially in settings with limited access to modern pharmaceuticals. Keywords: Phytotherapy, Herbal medicine, Diarrhea treatment, Antidiarrheal agents, Antibiotic resistance.

EXCLUSIVE BREASTFEEDING PRACTICE AND ASSOCIATED FACTORS AMONG FIRST-TIME MOTHER IN LARKANA

Exclusive breastfeeding (EBF) is defined as the practice of feedi: Exclusive breastfeeding (EBF) is defined as the practice of feeding infants solely with breast milk for the first six months of life, without introducing any other liquids or solid foods, except oral rehydration solutions, vitamins, or necessary medications. Objective: The main objective of the study is to find the exclusive breastfeeding practice and associated factors among first-time mothers in Larkana, Pakistan. Methods: This cross-sectional study was conducted at Sheikh Zayed Women's Hospital Larkana from June 2023 to December 2023. Data involve 345 breastfeeding first-time mothers as participants. Data were collected through a random sampling technique. Participants were first-time mothers with infants aged between 0-6 months, willing to provide informed consent were included in the study. Mothers with serious health conditions or those whose infants had medical complications preventing breastfeeding were excluded. Results: Data include 345 participants according to the criteria of the study. The majority of participants in the study were aged between 20-30 years (60.3%), with a smaller proportion under 20 years (9.3%) and over 30 years (30.4%). Most had secondary education or less (68%), while 32% had higher education. Regarding employment status, 59.4% were unemployed, and 40.6% were employed. In terms of socioeconomic status, 40% of participants were from low-income groups, 35% from middle-income, and 25% from high-income. In the study, 58% of participants reported practicing exclusive breastfeeding (EBF), while 42% did not. Conclusion: Exclusive breastfeeding rates among first-time mothers remain suboptimal, with significant factors such as maternal age, education, employment status, mode of delivery, and healthcare support playing key roles in influencing EBF practices.ng infants solely with breast milk for the first six months of life, without introducing any other liquids or solid foods, except oral rehydration solutions, vitamins, or necessary medications. Objective: The main objective of the study is to find the exclusive breast-feeding practice and associated factors among first-time mothers in Larkana, Pakistan. Methodology: This cross-sectional study was conducted at Sheikh Zayed Women Hospital Larkana during June 2023 till December 2023. Data involve 345 breast feeding first-time mothers as participants. Data were collected through a random sampling technique. Participants were first-time mothers with infants aged between 0-6 months, willing to provide informed consent were included in the study. Mothers with serious health conditions or those whose infants had medical complications preventing breastfeeding were excluded. Results: Data include 345 participants according to the criteria of the study. The majority of participants in the study were aged between 20-30 years (60.3%), with a smaller proportion under 20 years (9.3%) and over 30 years (30.4%). Most had secondary education or less (68%), while 32% had higher education. Regarding employment status, 59.4% were unemployed, and 40.6% were employed. In terms of socioeconomic status, 40% of participants were from low-income groups, 35% from middle-income, and 25% from high-income. In the study, 58% of participants reported practicing exclusive breastfeeding (EBF), while 42% did not. Conclusion: Exclusive breastfeeding rates among first-time mothers remain suboptimal, with significant factors such as maternal age, education, employment status, mode of delivery, and healthcare support playing key roles in influencing EBF practices.

International Trends in Zinc Treatment for Diarrhea.

Diarrhea is a leading cause of death among children <5 years of age and can have long-term adverse consequences for human development. The World Health Organization has recommended the therapeutic use of zinc for the treatment of diarrhea, along with oral rehydration solutions, since 2004. We studied recent trends in the use of zinc to treat diarrhea in 23 low- and middle-income countries. A repeated cross-sectional design of 46 Demographic and Health Surveys from 23 countries was used to estimate the average annual change in zinc treatment across recent years. The earlier surveys were conducted in different years from 2009 to 2014, and the latest surveys were conducted in different years from 2015 to 2023, with an average gap of 6 years between surveys. A diarrhea episode during the 2 weeks before the survey and the treatment of diarrhea using zinc and oral rehydration solutions among children <5 years old was identified using an interview with mothers. In the pooled sample, the treatment of diarrhea in children <5 years of age using zinc increased from 2% in the earlier surveys to 27% in the more recent surveys, or an average annual increase of 4 percentage points (pp). The prevalence of zinc treatment increased in all 23 countries, ranging from 9 pp per year on average in Sierra Leone to 1 pp in Cambodia. A large increase in the use of therapeutic zinc to treat diarrhea in children was observed in recent years. However, coverage remains incomplete.

Knowledge, Attitude and Practice Regarding Use of ORS in Diarrhoea by Mothers in an Island of Bangladesh

Introduction: The second leading cause of death in under-five children is diarrhea. ORS is a simple and highly effective therapy for managing diarrhea. However inappropriate knowledge of preparation and lack of use of ORS leads to health hazards including increased rate of mortality and morbidity. So aim of this study to assess the knowledge, attitude, and Practice of mothers towards the use of oral rehydration solution in the treatment of acute diarrhea in children. Methods: A cross-sectional study was carried out over eight months (1st May to 30th December 2023) among 510 mothers who had children of six months to five years and had recent episodes of diarrhea. Data were collected by using a semi-structured questionnaire in face-to-face interview. Data were analyzed by using SPSS software program.Results: Among 510 mothers, 47.05% were 20-30 years old, 29.80% were below 20 years and 23.13% were over 30 years. One fourth of them had no institutional education and 36.27% had primary, 20.78% and 18.23% had secondary and tertiary level of education respectively. 40.39% were from lower socioeconomic condition, 31.97% were from middle and 27.64% from upper socioeconomic condition. 100% of family used sanitary latrine though 73.72% use safe drinking water as a preventive part of diarrhea.89.98% of mother was aware about ORS but only 75.88% used ORS in recent episode of diarrhea, among them 63.03% prepared ORS correctly and 60.98% used adequate amount. Age of mothers was not corresponds with the correct preparation and practice of ORS but socioeconomic condition and level of education carried statistically significant value. Conclusion: Knowledge and practice of ORS preparation and used of ORS in recent episode of diarrhea among the mother was unsatisfactory. Improve the Maternal education and socioeconomic status will improve ORS correct preparation and use. Mothers should be taught the importance of optimal use and correct preparation of ORS in diarrhea. EWMCJ Vol. 12, No. 1&amp;2, January-July 2024: 43-49

Determinants of Acute Watery Diarrhea in Children Under Five Years: A Comprehensive Analysis

Background: Acute watery diarrhea (AWD), which has a sudden onset and is associated with a risk of severe dehydration, is primarily spread through unsafe water, poor sanitation, and inadequate hygiene. Socioeconomic factors, like low parental education and poverty, further increase risks. WHO-recommended interventions, including oral rehydration therapy, zinc supplementation, and rotavirus vaccinations, have reduced diarrhea-related deaths globally. Aim of the study: This study aims to explore the socio-demographic, environmental, and behavioral factors associated with childhood watery diarrhea, particularly in high-risk regions. Methods: This prospective observational study was conducted at the Department of Pediatric, 250 Bedded General Hospital, Khulna, Bangladesh, with 210 children aged 0–60 months presenting acute watery diarrhea, enrolled over one year July 2023 to June 2024. Eligible children met specific inclusion criteria, while exclusion was applied to cases of chronic diarrhea or unrelated pre-existing conditions. Data confidentiality was maintained, with ethical approval granted. The analysis involved descriptive statistics in SPSS (version 26) for comprehensive result interpretation. Result: The study included 210 children under five, with a mean age of 14.51±5.34 months; most were aged 7-12 months (38.10%), and 54.29% were male. Caregivers were predominantly aged 28.39±4.11 years, with 73.81% having completed primary education. Key findings included high MMR vaccination rates (62.38%), significant exclusive breastfeeding for six months (58.57%), and recent diarrhea reports among 20.95% of caregivers. In terms of WASH practices, 60.48% used piped water, 57.62% stored drinking water separately, and 95.71% had toilet facilities. Notably, 67.14% used water only for handwashing, and 45.24% washed hands with soap post-toilet use. Conclusion: Safe water, sanitation, and handwashing practices are essential to reducing acute watery diarrhea in children under five. Children in households with untreated water and inconsistent caregiver handwashing face higher risks. Targeted public health initiatives to improve water treatment and hygiene could greatly reduce diarrhea incidence and improve child health outcomes.

31 Impact of the amount of intravenous glucose administration on hospitalization for acute gastroenteritis in a paediatric emergency department

Abstract Background In case of failure of oral rehydration, children with acute gastroenteritis can be hydrated using intravenous (IV) solution. The choice of the intravenous solution itself (solutions containing dextrose versus crystalloids alone) and the glucose quantities to administer are not well established. Objectives The main objective of this study was to evaluate the impact of the amount of intravenous glucose provided to children treated for acute gastroenteritis on hospitalizations. Other objectives were to evaluate practice variation regarding the amount of glucose and liquid provided for IV rehydration in a paediatric emergency department (ED). Design/Methods We conducted a retrospective cohort study from 2019-2022 in a Canadian paediatric ED. We included children with acute gastroenteritis undergoing IV rehydration. Patient with hypoglycemia, metabolic disease or diabetes were excluded. The IV glucose administered during the initial four hours of rehydration was quantified. The primary outcome was hospitalization and return visit in the following seven days was a secondary outcome. 10% of the charts were evaluated in duplicate to assess inter-rater reliability. We examined glucose distribution at one and four hours, and utilized multiple logistic regression to relate glucose amounts with hospitalization and second visit, accounting for age, weight, bicarbonate levels, ondansetron use, and amount of liquid infused. It was estimated that the evaluation of 250 cases would have at least 50 admissions. Results Among 6,939 children evaluated for potential acute gastroenteritis, 250 met our inclusion/exclusion criteria. All variables included in the analysis had excellent inter-rater reliability. Notable variations existed in glucose quantities provided, both at one hour (first quartile: 87 mg/Kg; third quartile: 294 mg/Kg) and four hours (first quartile: 681 mg/Kg; third quartile: 1174 mg/kg) of rehydration. Multiple logistic regression showed a greater hospitalization risk with smaller amount of glucose administered during the initial hour (OR for each 100mg/kg increment: 0.60; 95%CI: 0.42-0.84) and four hours (OR: 0.76; 95%CI: 0.63-0.91) of rehydration. Moreover, children who received more dextrose during the first hour of rehydration were at lower risk of return visit (OR for each 100mg/kg increment: 0.52; 95%CI: 0.35-0.78), as well as during the first four hours (OR for each 100 mg/kg increment: 0.83; 95%CI: 0.73-0.94). Conclusion There was a wide practice variation in intravenous glucose provided to children with acute gastroenteritis. In this population, higher intravenous glucose amount was associated to a lower risk of hospitalization and lower risk of return visit.

Intermittent Preventive Treatment of Malaria in Pregnancy and the Impact on Neonates in African Countries as Assessed by Entropy Weight and TOPSIS Methods.

Background/Objectives: In regions of Africa with a high prevalence of malaria, pregnant women in their first or second trimester should be administered intermittent preventive treatment in pregnancy (IPTp). However, infants may contract malaria despite the IPTp therapy that their mothers have received. The objective of the present investigation was to assess the symptoms and various treatments for neonatal malaria. Methods: Entropy weight and TOPSIS were used to achieve the study goal. The TOPSIS multi-attribute decision-making system was used to assess newborn malaria symptoms and select the optimal treatment, even for mothers receiving IPTp medication during pregnancy. The entropy weight approach calculated TOPSIS attribute weights. The present research used UNICEF data for 14 African nations in 2023. Results: The results indicated that neonates whose mothers received IPTp therapy ultimately contracted malaria, with diarrhea being the primary symptom. It is important to note that health providers administer a combination of zinc and oral rehydration solution (ORS) to infants as the most effective treatment for malaria symptoms, thereby abandoning the first-line treatment for malaria, artemisinin-based combination therapy (ACT). Conclusions: The most effective treatment for neonatal malaria is a combination of zinc and ORS, although less than half of children in Africa have access to ORS. Therefore, the findings of this study may encourage African countries to prioritize co-pack therapy in their procurement and supply, healthcare provider training, and expenditures. This therapy will also help alleviate the symptoms of malaria in neonates.

Important practical aspects in the management of patients with shot bowel syndrome and intestinal failure

Short bowel syndrome is a gastrointestinal disorder resulting from massive resection of the small intestine. The most common causes of resection are acute mesenteric ischemia, Crohn’s disease, abdominal trauma, adhesive intestinal obstruction, intestinal malignancies, and radiation enteritis. Short bowel syndrome with intestinal failure is characterized by severe malabsorption-m aldigestion accompanied by abdominal pain, diarrhea, dehydration, and progression of protein-energy malnutrition. Many patients with SBS develop long-term clinical complications over time due to altered bowel anatomy and physiology or various therapeutic interventions such as parenteral nutrition and central venous catheterization. This review focuses on the most important aspects of diagnosis, treatment, and prevention of several complications that can occur in this patient population, including macronutrient and micronutrient imbalances, diarrhea, fluid and electrolyte imbalances, metabolic bone disease, biliary disorders, bacterial overgrowth in the small intestine, and complications related to venous access. The main therapeutic strategies for SBS with intestinal failure are: special diet, enteral nutritional support with semi-elemental mixtures, parenteral nutrition, oral rehydration, antimicrobal and antidiarrheal drugs, enzymes. Administration of glucagon-like peptide 2 analog, teduglutide, is clinically effective in reducing dependence on parenteral nutrition and improving quality of life. Management of patients with SBS with intestinal failure is a complex long-term process which requires dynamic clinical and laboratory monitoring.

Cross-sectional study exploring the prevalence and clinical manifestations of acute diarrhea among under-five children in primary care hospital in democratic republic of the congo

Background: Acute diarrhea (AD), which is defined as frequent passing of liquid stools compared to normal, is a serious and worrying problem and remains a concern for health care systems because of its high mortality cause in children under 5 years old. Our study aimed to present the prevalence and to describe the clinical manifestation of AD among under-five children. Methods: From June 2022 to May 2023, we conducted a retrospective, descriptive and cross-sectional study including all patients aged 0 to 5 years hospitalized for AD. Results: Out of 512 patients, only 197 (38.5%) children with AD were selected for our study. The average age is 25.5 months, and the sex ratio is 1.11. Some families (75.1%) have clean latrines, and 21.8% use water from the river. Inaccessibility to clean water and intolerance or food poisoning were the causes of acute diarrhea in children. Major signs and symptoms are fever, dehydration and vomiting. Weight loss and malnutrition are the major complications of AD in children. The treatment of AD is provided by oral rehydration solutions and antibiotics. Conclusion: The study highlights the significant prevalence of acute diarrhea among under-five children underscores the importance of preventive measures and government intervention, such as the introduction of rotavirus vaccination. However, conclusions regarding prevalence rates should be interpreted with caution due to the lack of detailed population data.

Oral rehydration in diarrhea: from history to current guidelines. A review

Acute gastroenteritis (AGE) is usually defined as a change in stool consistency (liquid or unformed) and/or an increase in the frequency of bowel movements, which can also be accompanied by vomiting and fever. Fever increases the metabolic rate by more than 1.5 times; for every 1°C increase in body temperature, fluid loss increases by 10%. AGE is a common cause of morbidity and mortality among infants and children. The prognosis is favorable if the condition is recognized promptly and appropriate treatment is started. The main goal of AGE therapy is to restore water balance and prevent dehydration, which can be achieved with an oral rehydration solution. The composition and proportion of the components of rehydration agents are described in the guidelines of the European Society for Paediatric Gastroenterology Hepatology and Nutrition, of which the Russian Society of Pediatric Gastroenterologists is a collective member, and such agents are fully consistent with the balanced formulations of RehydroStandard and Rehydron Bio rehydration agents. The latter includes the probiotic strain Lactobacillus rhamnosus GG, well studied and recommended by the European Society for Paediatric Gastroenterology Hepatology and Nutrition for acute intestinal infections since this strain reduces the duration and severity of diarrhea according to the results of studies. Rehydron Bio and RehydroStandard can be recommended for use in clinical pediatric practice.

Trends and inequalities in oral rehydration therapy and continued feeding for children under five with diarrhoea in Sierra Leone

BackgroundSierra Leone has improved child health outcomes in recent decades. However, diarrhoeal diseases remain a public health concern, particularly among children under five. This study investigates the trends and inequalities in oral rehydration therapy and continued feeding for children under five with diarrhoea in Sierra Leone in 2008, 2013 and 2019.MethodsThe analysis utilised data from the Sierra Leone Demographic Health Survey rounds conducted in 2008, 2013, and 2019. The software utilised for the calculation of various measures of inequality, including simple difference, ratio, population-attributable risk, and population-attributable fraction, was the World Health Organization Health Equity Assessment Toolkit. An inequality assessment was conducted for six stratifiers: maternal age, maternal economic status, maternal level of education, place of residence, sex of the child, and sub-national region.ResultsOur findings reveal that children under five with diarrhoea receiving oral rehydration therapy and continued feeding increased from 56.5% in 2008 to 59.7% in 2019 in Sierra Leone. Children of mothers aged 20–49 had more coverage over time than those with mothers aged 15–19. Children of mothers who are wealthy, more educated, and living in urban areas show a decrease in coverage with time compared to the poor, the lowly educated, and those residing in rural areas. Male children had higher coverage than female children. Regional inequality decreased slightly from 21.5 percentage points in 2008 to 21.2 percentage points in 2019.ConclusionThe findings revealed a mixed picture of progress in oral rehydration therapy and continued feeding for children under five in Sierra Leone. While national coverage has increased, inequalities persist. Children of older mothers and those from disadvantaged backgrounds have experienced improvements, while children of younger, wealthier, and more educated mothers in urban areas have seen a decline in coverage. The gender and regional inequalities remain. Expanding community-based health programs, providing subsidised or free supplies, and strengthening health systems in underserved areas are key strategies to ensure equitable and effective healthcare for all children in Sierra Leone.

Artemisia argyi polysaccharide alleviates osmotic diarrhea by enhancing intestinal barrier protection and anti-inflammation

Artemisia argyi polysaccharide (AAP) is a homogeneous polysaccharide with a molecular weight of 16 kDa, displaying anti-inflammatory, antioxidant, and anti-tumorigenic properties, and potential protective effects on intestinal barrier function. It is anticipated to serve as an efficient component in diarrhea treatment. This study aims to examine the impact of AAP on diarrhea severity, intestinal barrier function, and inflammation in diarrhea-induced rats. The results demonstrated that AAP treatment notably decreased the incidence of diarrhea, reduced its severity, and lowered the disease activity score in rats, while also increasing body weight. Oral administration of AAP augmented goblet cell counts and elevated mucin-2 expression, aiding in the restoration of the mucus barrier. Additionally, AAP treatment enhanced colonic microbial diversity by increasing the abundance of S24–7 and Lactobacillus, while decreasing the levels of Bacteroides, Clostridium, and Sutterella. Moreover, the AAP administration elevated the levels of steroid hormones, prostaglandins, and their derivatives. By inhibiting the TLR4/MyD88/NF-κB pathway, AAP mitigated the release of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) and increased the secretion of anti-inflammatory factor (IL-10). Overall, oral AAP administration effectively combats osmotic diarrhea by fortifying mucus barrier integrity and exerting anti-inflammatory effects, suggesting its potential use as an adjunctive agent in oral rehydration therapy.

Protein-based oral rehydration solutions for patients with an ileostomy: A randomised, double-blinded crossover study

Protein-based oral rehydration solutions for patients with an ileostomy: A randomised, double-blinded crossover study

Social perceptions of childhood diarrhea in Lubumbashi, Democratic Republic of the Congo: A qualitative study

Introduction: Infantile diarrhea remains a public health problem in the Democratic Republic of the Congo, where infant mortality linked to this disease remains high despite the proven efficacy of oral rehydration therapy. This study aims to understand the social perceptions of childhood diarrhea among mothers in Lubumbashi, by examining how they diagnose and treat the disease through both popular and biomedical representations.Material and methods: The study was conducted in Lubumbashi, the capital of Haut-Katanga in the DRC, utilizing a qualitative methodology that involved semi-structured interviews with 32 randomly chosen mothers. Selection criteria encompassed the number of children, educational level, religion, and age range (18 to 60). Information was gathered through documents and interviews conducted in Swahili, subsequently translated into French, and analyzed utilizing Jean-Blaise Grize’s ‘natural logic’ to grasp social representations.Results: The study revealed that the majority of mothers associated diarrhea with physical signs such as dehydration, watery stools, depressed fontanel, and sunken eyes. Several mothers attributed the diarrhea to cultural causes, such as the consumption of certain foods by pregnant women (e.g. “kabambale”) or the practice of breastfeeding by pregnant mothers. Local diseases such as “lukunga” and “kilonda ntumbo” are considered to be specific forms of diarrhea in popular culture. Treatments include traditional remedies such as ash applications and sitz baths.Conclusion: Perceptions of childhood diarrhea in Lubumbashi reflect a tension between cultural beliefs and biomedical knowledge, where rehydration is often neglected. The study recommends raising community awareness of the effectiveness of ORT while respecting local beliefs.

Evaluation of the determinants of uptake of oral rehydration salts with zinc in the management of childhood diarrhea in Kakamega County

Background: Diarrhea remains a significant public health concern, contributing to high child mortality, particularly in Sub-Saharan Africa and South Asia. Approximately 1.5 million cases of childhood diarrhea are reported annually in Kenya, with a prevalence of 16%. Despite the availability of affordable interventions like oral rehydration salts (ORS) and zinc supplementation, their utilization remains suboptimal in Kakamega County, where child mortality is 45 per 1,000. The combined impact of ORS and zinc in reducing childhood diarrhea and its consequences has not been adequately studied in Kakamega County. This study aims to assess the utilization of ORS and zinc in diarrhea management in Kakamega County. Methods: We utilized a cross-sectional design to evaluate current practices and outcomes in managing diarrhea among children under five years old. A random sampling approach was applied to ensure a representative sample. Key variables assessed included the frequency of diarrhea episodes, the use of ORS and zinc, and nutritional status. Statistical analyses, including Chi-square tests and descriptive methods, were used to examine the relationships between the variables in SPSS version 26. Results: Of the 246 children surveyed, 47.4% were under 10 months old. The study found that 26.8% of children had not received rotavirus vaccinations, and diarrhea was significantly (p&lt;0.05) associated with poor nutritional outcomes. ORS had strong support (69.4%), but zinc supplementation showed moderate support (54.3%). Conclusions: The study highlights the need for increased uptake of ORS and zinc supplementation, as well as enhanced vaccination coverage to prevent diarrhea-related deaths and malnutrition in Kakamega County.

Comparison between the dilution of electrolyte concentrate in milk or water for oral rehydration of diarrheal calves

The administration of oral electrolyte solution (OES) is the most used method to correct dehydration and electrolyte and acid-base imbalances in calves with diarrhea. To prepare OES, the electrolyte concentrate (EC) is diluted in water. Alternatively, it can be diluted in milk and the correction of dehydration depends on voluntary water intake. Although dilution in milk is used, its efficacy has not been fully proven. This study compared the effectiveness of two rehydration methods in correcting imbalances in diarrheal calves. Twenty-four neonatal calves with induced osmotic diarrhea were distributed into two treatment groups using a commercial EC: GM with EC diluted in the milk at meals; and GW with EC diluted in water (volumes of 5% BW, at 4 and 12 h). All were fed with milk (volumes of 4% BW, at 0, 8, and 16 h) and had free access to water. Clinical and laboratory variables were monitored over time up to 48 h. The calves presented moderate dehydration, hyponatremia, relative hyperchloremia and moderate strong ion metabolic acidosis. Both rehydration methods were effective in correcting imbalances and reestablishing plasma SID3 at the end of the day of treatment. Plasma volume expansion was faster in GW. Electrolyte-enriched milk is as efficient as OES for treating diarrheal calves.

Adherence to Clinical Practice Guidelines on the Management of Acute Infectious Gastroenteritis in Children as a Measure of Quality of Care Delivered by a Primary Care Facility in Rural Philippines: A Descriptive Retrospective Study.

This study aimed to describe the pattern of prescription and laboratory use in the management of infectious acute gastroenteritis (AGE) in children seen in a rural service delivery network (SDN) and to determine their adherence to the 2019 Clinical Practice Guidelines on the Management of Acute Infectious Diarrhea in Children and Adults from the Department of Health (DOH). A descriptive retrospective study was done using the electronic medical records (EMR) of patients less than 19 years old seen by the rural SDN from April 2019-2021 and diagnosed with infectious AGE. Data were extracted on diagnostic and therapeutic management. Adherence to strong CPG recommendations focusing on rehydration, zinc supplementation, rational laboratory use, and antibiotic prescription was chosen as indicator of quality of care. Adherence of less than 70% was defined as low. There were 227 infectious AGE cases, with 72% diagnosed under non-specific infectious AGE. Fifty two percent (52%) were prescribed with low-osmolarity oral rehydration solutions (ORS), while 74% were given zinc. Stool analysis was done in 25% of cases while CBC was done in 20%. Top antibiotics given were metronidazole at 44% and cotrimoxazole at 33%. There was low adherence to prescribing low-osmolarity ORS for rehydration (52%) and to deferring routine antibiotic prescription for non-specific infectious AGE cases (24%). Adherence to deferring routine stool analysis and CBC were relatively high at 73% and 70%, respectively while adherence to antibiotic use for indicated cases was high at 95%. Frequency of diagnostics ordered were low resulting to high adherence rates to recommendations concerning judicious laboratory use. Prescription frequency of appropriate antibiotics and interventions for AGE were low, leading to low adherence rates to recommendations concerning rational antibiotic use and prescription of cornerstone therapies for infectious AGE.

Zinc adherence among caregivers of under five children with diarrhea in Gondar City, Northwest Ethiopia

IntroductionZinc with oral re-hydration salt supplementation provides much improved outcomes for managing childhood diarrhea. There is scarcity of evidence in the study area regarding zinc supplementation adherence and factors associated with. Thus, the aim of this study was to assess zinc supplementation adherence and associated factors among caregivers of under five children with diarrhea attending health centers in Gondar City.MethodsAn institutional based cross-sectional study was conducted with 405 caregivers of under-five children with diarrhea who received zinc supplementation in Gondar City health centers. Bivariable and multivariable logistic regression analysis were computed.Results35% (95% CI: 29.91, 39.21) of caregivers of under five children adhered for zinc supplementation. Adherence was observed among caregivers with good knowledge about zinc supplementation (AOR = 3.01 95%CI = 1.73, 5.24), and who received counseling (AOR = 8.4, 95%CI = 4.66, 15.13), presence of side effects (AOR = 0.35, 95% CI 0.20, 0.65) was negatively associated with zinc supplementation adherence.ConclusionIn the study area, more than one third of children with diarrhea were adhered to zinc supplementation. Thus, improving the knowledge of caregivers and enhancing counseling services on benefits, dosage, duration and side effects of zinc supplementation are vital to improve adherence in the area.

Mobile phone call reminders to improve oral rehydration salt and zinc adherence for acute diarrhea in children: a single-center, randomized controlled trial

BackgroundLow-osmolarity oral rehydration salt (ORS) and zinc therapy effectively manage diarrhea in children under five years of age, offering both short- and long-term benefits. Despite this, caregivers’ adherence to ORS and zinc is often unsatisfactory due to factors such as forgetfulness, resolution of symptoms, and underestimation of the disease’s severity. This study assessed the effect of mobile call reminders on ORS and zinc tablet adherence among children with acute diarrhea in a secondary-level health facility in Kwara State, Nigeria.MethodsUsing an open-label, randomized controlled trial design, this study compared caregiver-child pairs with acute diarrhea aged 6–59 months who received standard instructions (SI) alone (control group) and an intervention group (IG) who received SI plus phone call reminders on days three and seven of zinc sulfate therapy. All participants used a pictorial diary to track loose/watery stools and ORS and zinc tablet treatments for ten days. The primary outcome measures were independent and combined adherence to ORS and zinc therapy. The secondary outcomes were independent and combined adherence scores, defined as the percentage of times the ORS was given post-diarrhea and the percentage of prescribed zinc tablets administered out of ten.ResultsA total of 364/400 mother–child pairs completed the study. The percentage of mothers with full adherence in the intervention group was 82.5% for ORS, 72.1% for zinc, and 58.5% for combined use, compared to 78.8%, 60.8%, and 43.6%, respectively, in the control group. The odds of full adherence to ORS and zinc were 1.6 and 1.7 times higher among intervention mothers [ORS: OR = 1.561, 95% CI = 0.939–2.598, P = 0.085; zinc: OR = 1.671, 95% CI = 1.076–2.593, P = 0.022], and 1.8 times higher for combined use according to WHO guidelines [OR = 1.818, 95% CI = 1.200–2.754, P = 0.005]. The mean adherence scores for the intervention group were higher than those for the control group by 4.1% (95% CI = 0.60–7.60) for ORS, 7.3% (95% CI = 3.74–10.86) for zinc, and 5.7% (95% CI = 3.23–8.17) for the combined treatment.ConclusionPhone reminders can effectively improve consistency of home treatment administered by caregivers for children under five years old.Trial RegistrationThe study was registered retrospectively (17/3/2023) with the Pan African Clinical Trial Registry (PACTR202301560735856).

Risk factors associated with early childhood diarrhea: a case-control study

Purpose This study aims to explore the link between prevalent risk factors for early childhood diarrhea, including hygiene, feeding, weaning practices and maternal education and the occurrence and severity of early childhood diarrhea in Saudi Arabia. Design/methodology/approach A case-control study was conducted, involving 98 mothers from the Eastern Region of Saudi Arabia (51 cases and 47 controls). Data were collected from both hospital and community sources. The collected data were statistically analyzed and depicted using descriptive statistics and frequency tables. Findings Demographic data revealed that 60% of mothers were housewives, 75% had normal deliveries and all babies were full term. In the study cohort, 44% of children aged one to two years. Four domains were compared: diarrheal management, hygiene, weaning and feeding practices. Diarrheal management was suboptimal in some cases: 29% increased fluid intake, 10% maintained adequate food intake, 50% sought medical advice, 58% were familiar with oral rehydration solutions and only 37% used them. Hygiene practices were deficient, with 35% using wipes or sanitizers, 64% handwashing before feeding and 52% adhering to the recommended 10-s duration. Controls exhibited better hygiene practices. Weaning practices were generally similar, with no significant differences between the two groups. Originality/value To the best of the authors’ knowledge, this is the first study to collectively report on the risk factors linked to early childhood diarrhea in Saudi Arabia. This study yields significant insights, highlighting the crucial role of managing diarrhea, educating mothers and implementing proper household practices in impacting the occurrence and severity of this perilous ailment.